Biosimilars; The Canadian province of British Columbia said on Monday that its public drug plan will switch as many as 20,400 patients from three branded biologic drugs to cheap near-copies called biosimilars, saving an estimated C$96.6 million ($71.9 million)over three years.

The new policy from the province’s PharmaCare program targets Johnson & Johnson’s Remicade and Amgen’s Enbrel which treat rheumatoid arthritis and related autoimmune conditions, and Sanofi’s long-acting insulin Lantus. It is the first of its kind in a Canadian public plan; and could pave the way for similar programs across the country.

Biologic, or biotechnology, drugs are large molecules; made from living cells, and tend to be expensive. They work in the same way as the biologics they mimic, but unlike generics of less complex pills, they are not identical to the drug they are copying.

Biosimilars might be the future

Biosimilars are a necessary step to ensure PharmaCare provides existing coverage; but for more people and funds new drugs well into the future,” said the British Columbia government in a statement. In Canada, pharmacists cannot swap biosimilars for their branded predecessors once patents expire the way they can with generics. Doctors must specifically prescribe the biosimilar, and they have been slow to do that. European countries have been quicker to adopt the less expensive versions.

Sanofi Canada said it was disappoint and regret that BC; “did not take the opportunity to find an alternative solution to preserve this treatment option”. Amgen said it was “disappoint the British Columbia chose not to consider alternatives to address their financial concerns”. The company, which is developing its own biosimilars of rivals’ drugs, said it supports biosimilars for new patients.

Drug coverage

J&J’s Janssen unit did not respond to a request for comment. Canadian law says provincial governments must cover medically necessary care by doctors; but prescription drugs are paid for through a patchwork of public; and employer-based insurance plans. While every province offers some drug coverage, it is often limited to the elderly or people; with low income or exceedingly high drug costs. BC’s system is unusual because it covers most residents, with deductibles based on income.

BC said patients with some types of arthritis, diabetes and plaque psoriasis would have until Nov. 25, 2019, to switch to a biosimilar. After that, the original biologic drugs would only be covered for those indications; but under exceptional circumstances. At the same time, BC announced that it would begin covering two newer biologics: Boehringer Ingelheim and Eli Lilly’s diabetes drug Jardiance, and Eli Lilly’s Taltz, which treats psoriatic arthritis.